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Health Care

What You Need To Know As Health Care Deadline Looms

Originally published on Tue March 18, 2014 1:51 pm

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MICHEL MARTIN, HOST:

This is TELL ME MORE from NPR News. I'm Michel Martin. The Obama administration announced yesterday that 5 million Americans have now enrolled in the Affordable Care Act, and that might be surprising news for some who tried to sign up and were met by major website problems early in the rollout. If you are not one of those 5 million, you still have about two weeks to sign up or figure out if you might be able to stay in a plan you already have.

Now we realize that sounds complicated so to help us sort it all out we've called, once again, one Mary Agnes Carey. She is a senior correspondent for Kaiser Health News, and she's been joining us from time to time to talk about the Affordable Care Act and other issues in health care. Welcome back. Thanks for joining us once again.

MARY AGNES CAREY: Thanks for having me.

MARTIN: So first of all, tell us about this deadline coming up in two weeks. Who needs to pay attention to it?

CAREY: If you don't have health insurance right now and - or you currently have insurance, but it's up for renewal, you need to look at some of the options that are out there. March 30 is your enrollment deadline. If you don't enroll - March 31, rather. If you don't enroll in health insurance by then, you could face a penalty. It's $95 or 1 percent of income for the first year. People forget about that 1 percent of income 'cause it's whichever is higher.

So this is the time now to get on the website, look at the options. You might qualify for a subsidy. You might qualify to be in the Medicaid program if your state is expanding Medicaid. So now is the time before the end of the month.

MARTIN: How is the government going to figure out if you signed up - if you should have signed up and didn't?

CAREY: You're supposed to say on your tax return whether or not you're signed up. And also, insurance companies are supposed to tell the government who they've signed up. So through a reconciliation process when you file taxes in 2015, they're supposed to know who is signed up and who isn't.

MARTIN: Now the White House wanted to give some consumers more time to stay with plans that do not comply with the health law. Many people might remember the big to-do last year when a number of plans that didn't meet all the requirements of the new law started dropping people. And that was - people were upset about this. So the White House wanted to give people more time to stay with these plans even if they don't conform to the requirements of the law. And this was part of a revision that included some other changes. Is there something we really need to know right now about that?

CAREY: Well, there's a couple of things. To your point, back in November, we want to remember that President Obama said if you were in a health insurance plan that didn't comply with the Affordable Care Act and your health insurance plan wanted to still offer it - these are plans in the individual market - if the insurer would offer it, the state would allow it. You had an extra year. So earlier this month, they said we're going to make that two extra years.

Again, the insurance copy has to continue to allow it. The state has to continue to allow it the insurance commissioner has that kind of leeway. This big rule that you're talking about that came out earlier in the month also extended the enrollment period for 2015. It will start November of this year - November 15 of 2014 through February 15 of 2015. That's an extra month they previously allotted. There's also some higher limits on cost sharing, and here we're talking about your deductibles, your co-pays and co-your coinsurance. Those limits, in 2015 for an individual, will increase to $6,600 from the current $6,400. And for families, those limits will rise to $13,200 from $12,700.

MARTIN: Now Kathleen Sebelius, the secretary of health and human services, told lawmakers this month that the Obama administration would not extend the deadline for people to sign up for health insurance or delay the requirement for most Americans to have coverage. And that's that March 31 deadline that you were telling us about. But what about people who have been dropped from medical insurance plans, you know, for whatever reason? Maybe - you know, for whatever reason - do they have some leeway there?

CAREY: Well, if you have been - your health insurance was canceled and you need to look for another option, if you are - you can find an option that you can afford, you'll be fine. If you find an option - you can't find an option, rather, deemed as unaffordable, you can apply for one of these hardship exemptions. But this is causing some controversy because opponents of the law are saying the way that some of these hardship exceptions are drafted, it's basically a big truck that anyone can drive through and avoid the mandate. So there is some flexibility if people have had their plans canceled and can't find one they deem as affordable for them.

MARTIN: Well, tell us a bit about what you're seeing just as you're reporting this. I mean, one of the things that's been interesting about this throughout the course of this big, new law being rolled out is what seemed to have been kind of some unexpected potholes, something that's on all of our minds right now as we're still cleaning up from our last kind of snowstorm. So are there any other kind of interesting kind of potholes or corners of this that have emerged that perhaps were not anticipated?

CAREY: This conversation over what a narrow network is, this is something that started before the health law, but it's continued to happen as the exchanges, these online marketplaces have been rolled out. Do the health plans have enough access to doctors and hospitals, for example? That's something that is starting to emerge as an issue that we didn't really think about a lot before. I think it's interesting how confused people still are. We find this constantly in our reporting and questions that are sent to us at Kaiser Health News. People don't understand the basic rules of the road with the health law. Do they have...

MARTIN: Well, what are they confused about?

CAREY: They are confused about how to enroll. They're confused about how the subsidies work. They may live in a state where the governor and/or the legislator has decided not to expand Medicaid, and they might qualify for that expansion. And so they want to get a subsidy and purchase coverage, but if they're below a certain income level, they can't do it. There's a lot of twists and turns in this law that people are confused about. I know we're trying to explain it. You're certainly trying to explain it, but a lot of confusion still remains.

MARTIN: What do you recommend to people 'cause obviously we can't, as much as we would like to, you can't as much as you would like to answer every question that people might have about this so what do you recommend that people do? Is there a first place that they should go to just get some basic things answered?

CAREY: There's a variety of things they can do. Healthcare.gov is a pretty good website in the sense of answering questions about the law. I know people have had a hard time navigating that system, but I have found that website is pretty good. There are nationwide networks of sisters, navigators. These are people created - positions, rather, created in the health law to help you understand the health law.

Can you find someplace in your community - a senior center, for example, any kind of community outreach that can help you enroll in the health plan? Do you know anyone who sells insurance? Do you know a broker? Do you know an insurance agent? Go there to try to get questions. If there's a particular health insurance company that your neighbor uses, for example, see if that health - that insurance company has information for you. And also, if your state is doing a health insurance exchange, you can find out healthcare.gov. You can go there.

MARTIN: Mary Agnes Carey is a senior correspondent for Kaiser Health News. We want to tell you, once again, that is a new service, and it is not affiliated with Kaiser Permanente. And she was kind enough to join us once again in our studios in Washington, D.C. Mary Agnes, thanks so much for joining us once again.